| NPI | 1740240738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1251281) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3559) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-11-04 |